Innovations in diagnosis and treatment for esophageal cancer

In recent years, the number of cases of adenocarcinoma of the esophagus (or gullet) has been on the rise. At the same time, however, new ways of treatment are improving the outlook for patients. In the current issue of Deutsches Ärzteblatt International (Dtsch Artzebl Int 2011; 108[18]: 313-9), Angelika Behrens and her working group report on innovations in diagnosis and treatment.

The main cause of this cancer is reflux of gastric acid from the stomach, with heartburn as the main symptom. Other risk factors are being male, being overweight, and having relatives with this disease.

Today we are able to discover and treat adenocarcinoma (Barrett's carcinoma) at an early stage. This has chiefly been made possible by the introduction of high-definition videoendoscopy and endosonography (endoscopic ultrasound). Locally restricted tumors can be resected endoscopically. For locally advanced Barrett's carcinoma, the standard treatment is surgery combined with chemotherapy. For esophageal cancer that has already metastasized, there are new approaches to therapy based at the molecular level. So-called molecular targeting uses antibodies or small molecules to alter signal transduction directly inside the tumor cell and thus inhibit growth.

The authors also report on their experience of treating over 1000 patients with this cancer.